Three-Dimensional Mapping in Interventional Electrophysiology: Techniques and Technology

Douglas L. Packer, M.D.


J Cardiovasc Electrophysiol. 2005;16(10):1110-1116. 

In This Article

Limitations of Technology

The obvious downside to this technological explosion is cost. The question also arises as to whether or not this technological "tour de force" is necessary in an individual EP lab. Certainly, standard EP mapping systems have already been highly useful for facilitating the successful completion of a wide variety of ablative interventions. Whereas ablation in the early 1990s was limited to atrioventricular (AV) nodal reentrant tachycardia, accessory pathways, and atrial flutter, the specific cataloging of both anatomy and physiology has contributed substantially to the expansion of ablation to atypical flutters, VT, congenital heart-disease-related atrial flutters, and atrial fibrillation. In this sense, the technology is already facilitating, if not enabling. Subsequent studies will be needed, however, to show that this translates into improved outcomes at cost savings.

In this regard, it may be that these approaches will be the "great equalizer" for facilitating complicated studies that otherwise would require an insurmountably steep learning curve. Nevertheless, future generations of systems will have to be affordable within the context of prevailing reimbursement paradigms. This would be facilitated by multiple-use catheters, inexpensive higher resolution imaging and more automatic segmentation, and robust registration software, all designed to reduce procedure times and therefore increase the number of procedures that can be safely performed in a day. Undoubtedly, this will occur and will lead to even better, expedited care for patients with substantial arrhythmia burdens.

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